Esketamine on Postpartum Depression in Cesarean Section Women (EKET)

Effect of Prophylactic Esketamine on Postpartum Depression in Cesarean Section: A Multicenter, Prospective, Randomized, Controlled Study

The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Central South University, The First Affiliated Hospital of Anhui Medical University, The First Affiliated Hospital of University of South China, Guangdong Women and Children Hospital, Third Affiliated Hospital of Zhengzhou University, First Affiliated Hospital of Guangxi Medical University, Dalian Municipal Central Hospital, Shandong Jining No.1 People's Hospital, Maternal and Child Health Hospital of Hubei Province

This study was to explore the preventive effect of esketamine on postpartum depression in cesarean section, and to evaluate the safety of the drug

Studies have shown that esketamine can treat clinical refractory depression, the drug takes effect quickly, can quickly eliminate the patient's suicide intention, low-dose maintenance treatment is conducive to the stability of the patient's condition, and less adverse reactions, is the current hot spot of antidepressant drug research. Esketamine has been approved by FDA for the treatment of refractory and suicidal depression, but can it effectively prevent and treat postpartum depression? It is not clear. Based on this, this study aims to explore the preventive effect of prophylactic administration of esketamine on postpartum depression in cesarean section, and evaluate the safety of the drug.

The incidence of PPD: the EPDS scale was assessed by face-to-face or telephone interview of the Puerpera 24 h, 7 d, 30 d, 60 d and 90 d after delivery. EPDS score ≥ 10 was defined as antenatal depression or postpartum emotional disorder.

Assign a researcher to determine the order of patients and coordinate the relationship between researchers; For each patient, an anesthesiologist was assigned to manage anesthesia and collect intraoperative data; A researcher who was not aware of the protocol was assigned to conduct preoperative evaluation and postoperative follow-up, and received training on evaluation methods before the study.

15 minutes after umbilical cord amputation, the patient was intravenously injected with 10 ml normal saline

15 minutes after umbilical cord amputation, the patient was intravenously injected with 0.25mg/kg esketamine, PCIA regimen: sufentanil 100 μ g, esketamine 80 mg, diluted to 100 ml with 0.9% normal saline, set analgesia pump background infusion dose 2 ml/h, single bolus dose 2 ml, locking time 8 minutes.

After delivery, the parturient was given a loading dose of esketamine, and then a small dose of esketamine was added into PCIA analgesia pump

Inclusion Criteria: Elective cesarean section; 18-40 years; Primipara; Singleton pregnancy; Sign informed consent. Exclusion Criteria: ASA grade III and above; Intracranial hypertension; Hypertension; Severe heart disease; Hyperthyroidism patients without treatment or insufficient treatment; Liver and kidney dysfunction; Preeclampsia or eclampsia; Mental disorder, mental retardation; Drug abuse and alcoholism; Contraindication of intraspinal anesthesia; The preoperative EPDS score ≥10; Participated in other clinical studies.